Table 2.
Summary of the studies on preoperative breast cancer radiotherapy
| Author and year | Inclusion criteria | n of pts | Treatment | Systemic therapy | Time to surgery | Postoperative RT | Outcomes | Toxicity | Follow-up (months) |
|---|---|---|---|---|---|---|---|---|---|
| Bondiau et al., 2013 [21] | Unifocal BC not suitable for BCS, HER2 negative | 26 | Robotic SBRT (Cyberknife)/19,5–31.5 Gy/3 fr (5 dose levels) | CHT | 4–8 weeks after last CHT | Yes, 3D-CRT | pCR 36% (NS) 92% BCS rate 96% ORR | none | 30 |
| Horton et al., 2015 [22] | Age > 55 years, T1 BC or low- intermediate DCIS ≤2 cm, cN0, ER + and/or PR+, HER2- | 32 | IMRT/15–21 Gy (3 dose levels)/1 fr | none | within 10 days after RT | Yes (Only to patients not satisfying eligibility criteria after BCS) | Significant increase in MRI post- radiation vascular permeability and decreased cellular density | 13 Grade2; 2 Grade 3 | 23 |
| van der Leij et al., 2015 [23] | Age > 60 years, invasive, unifocal BC ≤ 3 cm on MRI, non-lobular, negative SNB | 70 | 3D-CRT or IMRT or VMAT/40 Gy/10 fr | none | 6 weeks after RT | No | 2 local recurrences | 11% mild-moderate 23 induration at 12 months; 2% mild-moderate fibrosis at 24 months | 23 |
| Nichols et al., 2017 [24] | Unifocal invasive BC < 3 cm at mammography or MRI, cN0 | 27 | 3D-CRT /38.5 Gy/10 fr (twice daily) | none | > 21 days after RT | No | pCR 15% (NS) ORR 88.9%; Ki-67 reduction after RT in 70.4% | PRCO fair and poor in 17 and 5% at 1 year, respectively | 43 |
| Tiberi et al., 2020 [27] | postmenopausal status, age > 65 years, stage I (cT1N0) invasive BC, unifocal luminal A, ER+, her2-negative, G1–2 | 10 | SBRT 20 Gy/1fr | none | 11–13 weeks after RT | Yes if: Grade 3, lymphovascular invasion, pT4, triple neg, extensive DCIS, tumor size > 3 cm, lobular histology |
pCR: 0 (median residual cellularity was 3% in 8 patients; for the other 2 patients no response at all was observed) |
none | < 12 |
| DOSIMETRIC STUDIES | |||||||||
| Charaghvandi et al., 2015 | Tumor size up to 30 mm, scheduled for BCS and WBI | 20 | IMB and VMAT 15 Gy/1 fr + integrated ablative boost of 20 Gy | none | – | – | Dosimetrically feasible with IMB and VMAT | – | – |
| Yoo et al., 2015 [44] | Patients enrolled on a preoperative, dose escalation, single fraction PBI clinical protocol | 16 (8 + 8) | 3D-CRT, non-coplanar IMRT, coplanar IMRT, VMAT 15 Gy/1fr and 18 Gy/1 fr | none | – | – | IMRT plans provided homogeneous and conformal target coverage, skin sparing, and short delivery time | – | – |
List of abbreviations: 3D-CRT 3D conformal RT, BC breast cancer, BCS breast conserving surgery, CHT chemotherapy, CTV clinical target volume, DCIS ductal carcinoma in situ, FX fraction, IMB interstitial multicatheter brachytherapy, IMRT intensity modulated RT, MRI magnetic resonance imaging, PBI partial breast irradiation, pCR pathological complete response, RT radiotherapy, SBRT stereotactic body radiotherapy, VMAT volumetric modulated arc therapy, ER estrogen, PR progesterone, HER2 human epidermal growth factor receptor 2, SNB sentinel node biopsy, NS not statistically significant, ORR objective response rate, PRCO patient reported cosmetic outcome